Ethmoid Involvement Research Articles

Anatomical Variations Of Osteomeatal Complex In Chronic Rhinosinusitis Patients

Aim: To study the anatomical variations of osteomeatal complex commonly associated with paranasal sinus disease using computed tomography.Methodology: A prospective longitudinal study was conducted in the ENT department of IMCHRC, Indore for a period of one year. All the adult patients with complaints suggestive of chronic rhinosinusitis for a period of more than 12 weeks, a total of 100 patients were involved in the study.Results: In our study we observed the association between sinusitis and the anatomical variations of the osteomeatal complex and it has been found pneumatized middle turbinate to have strong significant association(p<.05) with maxillary, frontal and anterior ethmoidal sinusitis. Deviated Nasal Septum was the most common finding, which was significantly associated with anterior ethmoid sinusitis. Haller cells showed association with anterior ethmoid involvement (69.2%). Bilaterally obliterated osteomeatal complex had significant association with involvement of posterior ethmoidal sinus. Amongst the patients with Paradoxical uncinate process, all (100%) showed involvement of sphenoid sinus.Conclusions: The importance of CT scan is emphasized in patients with persistent symptoms to identify the anatomical variations that may contribute to the development of chronic sinus mucosal disease.

Ethmoidal drug‐eluting stent therapy is not superior to nasal corticosteroid spray in the prevention of endoscopic sinus surgery: Results from a randomised, clinical trial

To evaluate whether an ethmoidal drug-eluting stent (DES) (the Relieva Stratus™ MicroFlow Spacer) could better prevent endoscopic sinus surgery (ESS) than standard non-invasive therapy using corticosteroid nasal spray in patients suffering from chronic rhinosinusitis (CRS). Prospective, randomised clinical trial. Tertiary referral centre. Sixty-three adult patients with ethmoidal involvement in cone beam computerised tomography (CBCT) whose first-line medical treatment with topical corticosteroids had failed and who were candidates for ESS were randomised either to a DES group, which received triamcinolone acetonide stents (n=34), or to a topical intranasal corticosteroid group (n=29) that used optimally dosed triamcinolone acetonide nasal spray. Patients were followed up prospectively for 6months and at 36months. Freedom from ESS was the primary endpoint. Further, we identified those factors predicting ESS. At 6months, ESS could be prevented in almost half of the patients in both groups (DES 13/28, 46.4%, nasal spray 14/29, 48.3%). At 36months, 20/28 (71.4%) patients in the DES group and 18/29 (62.1%) in the nasal spray group had been operated. The differences were not statistically significant at either timepoint. Patients who smoked (14/19, 73.7% vs 16/38, 42.1%) were more likely to be operated at 6months. Endoscopic sinus surgery can be prevented using both therapies in the medium term in almost half of cases with neither therapy being statistically superior. This effect was somewhat diminished in the long term with a trend towards more patients being operated in the DES group. Considering the additional costs, the need for general anaesthesia and the potential side effects associated with DES, its potential clinical role appears to be limited. Smoking was significantly associated with ESS.

Sinonasal papillomas in Quito, Ecuador

Background: Sinonasal inverted papilloma is an unusual tumor of the nasal cavity and paranasal sinuses with potential for malignant transformation. The objective was to review the experience mostly using a similar open surgical approach.Methods: Twenty-eight patients were included. Mean age was 54, 57% of male gender. five patients were previously operated elsewhere, twenty-five had unilateral complete nasal obstruction and mean duration of symptoms was 8months. A computed tomography was performed in all patients. The tumor was located within the nasal cavity in 9 cases, limited to the ethmoid sinus complex in one, extended to the maxillary sinus in 16 and to the nasopharynx or palate in one, each. Mean size was 5.2cm. Twenty-seven cases were benign and one was a transitional carcinoma originated in an inverted papilloma. Surgical resection of the tumor was performed through a Denker’s approach in all the benign cases except a lateral rhinotomy in one recurrent lesion of limited ethmoid involvement. A partial maxillectomy was performed in the patient with malignancy. Minor postoperative complications occurred in 3 patients which was nasal bleeding, a cellulitis of the cheek with exophtalmus and an oro-antral fistula.Results: After a mean follow-up of 33.6months, recurrent benign tumors were easily resected through the same approach in 5 patients. All patients have currently no evidence of disease.Conclusions: Denker’s approach was a very useful, rapid and safe surgical approach for treatment of middle size or extended sinonasal inverted papillomas and remains an alternative to current endoscopic resection.

Olfaction after Endoscopic Sinus Surgery of Chronic Rhinosinusitis

Objectives: Chronic rhinosinusitis (CRS) is one of the most common causes of olfactory dysfunction. After endoscopic sinus surgery (ESS), olfactory function may improve in most cases, but may not in others. The purpose of this study was to investigate the prognostic factors for olfaction improvement after endoscopic sinus surgery in CRS. Methods: A total of 103 patients (175 nostrils) with CRS who underwent ESS were studied. We performed olfactory function test for all patients using the butanol threshold test (BTT) and Cross Cultural Smell Identification test (CC-SIT) preoperatively and postoperatively. The patients’ subjective symptoms were also recorded using the visual analog scale (VAS) pre- and postoperatively. We also analyzed the duration of disease and preoperative computed tomography by Lund-Mackay score. Results: The improvement of olfactory function after ESS in patients with longer duration of symptoms was not significantly lower than in patients with shorter duration. In multivariable study, anosmics had better improvement than hyposmics in recovery of olfaction. There were significant differences in anterior ethmoid involvement between responder and non-responder group. Conclusions: The improvement of olfaction after ESS mainly depends on the degree of preoperative olfactory function and involvement of anterior ethmoid involvement. Therefore, for the better outcome of ESS especially in olfactory function, early and proper treatment (including ESS) for CRS will be necessary.

Frequency of the odontogenic maxillary sinusitis extended to the anterior ethmoid sinus and response to surgical treatment

Objectives: Odontogenic sinusitis usually affects the maxillary sinus but may extend to the anterior ethmoid sinuses. The purpose of this study is to determine the percentage of odontogenic maxillary sinusitis extended to the anterior ethmoid sinuses and determine also the surgical resolution differences between odontogenic maxillary sinusitis and odontogenic maxillary associated to anterior ethmoidal sinusitis. Study Design: This is a retrospective cohort study performed on 55 patients diagnosed of odontogenic sinusitis and treated surgically by functional endoscopic sinus surgery. Results: This study showed that 52.7% of odontogenic maxillary sinusitis spreads to anterior ethmoid, causing added anterior ethmoid sinusitis. We found that 92.3% of the odontogenic maxillary sinusitis (who underwent middle meatal antrostomy) and 96.5% of the odontogenic maxillary sinusitis extended to the anterior ethmoid (treated with middle meatal antrostomy and anterior ethmoidectomy) were cured. Conclusions: Ethmoid involvement is frequent in maxillary odontogenic sinusitis. The ethmoid involvement does not worsen the results of “functional endoscopic sinus surgery” applied to the odontogenic sinusitis. Key words:Odontogenic maxillary sinusitis, ethmoiditis, functional endoscopic sinus surgery.

Malignant Fibrous Histiocytoma/Undifferentiated High-Grade Pleomorphic Sarcoma of the Maxillary Sinus

Malignant fibrous histiocytoma (MFH) also known as undifferentiated high-grade pleomorphic sarcoma (UHPS) is a soft tissue sarcoma, composed of undifferentiated mesenchymal tumors possessed fibrohistiocytic morphology without definite true histiocytic differentiation. Head and neck localization is very rare, showing an incidence ranging from 4 % to 10 % in different series of investigations. The most frequent involved sites in UHPS are the neck and parotid, followed by the scalp, face, anterior skull base and orbit. Upper aerodigestive tract, lateral skull base and ear are rare locations. The incidence of the lymphatic metastases is also rare. The aim of this article is to report a case of UHPS in the maxillary sinus with palatal, orbital and ethmoidal involvement, with lymphatic metastasis and its surgical treatment. In addition, we review the literature of similar cases of the past 12 years.

Fungus ball of the paranasal sinuses: Experience in 160 patients treated with endoscopic surgery

Herein we present our experience in the management of fungus ball (FB) of the paranasal sinuses. Preoperative imaging strategy and findings, surgical technique, and pathologic and microbiologic results are discussed. Retrospective chart review of patients with FB of the paranasal sinuses who underwent endoscopic surgery at the Department of Otorhinolaryngology of the University of Brescia, Italy. From January 1990 to December 2006, 160 patients with sinonasal fungus ball were treated with a purely endoscopic approach. All patients underwent preoperative computed tomography (CT) and/or magnetic resonance (MR) imaging; an endo-oral dental x-ray or orthopantomography and odontological evaluation were also performed in patients with maxillary sinus localization. All removed material was sent for pathologic and microbiologic evaluation. All patients were prospectively followed with endoscopic control every 2 months during the first postoperative year and subsequently every 6 months. The patient cohort included 118 females and 42 males, with an age from 19 to 85 years (mean, 52.7 years). FB was located in the maxillary sinus in 135 (84.4%) patients; in two cases both sinuses were affected. Sphenoid and ethmoid involvement was observed in 23 (14.4%) and 1 (0.6%) patients, respectively. Simultaneous ethmoid and sphenoid involvement was found in one (0.6%) case. In all patients complete removal of fungal debris was obtained through wide sinusotomy. No recurrence was observed. Endoscopic surgery is a safe and effective treatment for paranasal sinuses FB. A proper imaging study by MR and/or CT can address diagnosis, which is based upon detection of fungal hyphae at histology.

La douleur en tant que symptôme en ORL

Pain is very frequent in otolaryngology disease: headaches, facial pain, earaches, and neck pain. The search for nasal pathology with maxillary sinus, sphenoidal, or ethmoidal involvement is part of the workup for headache. Facial pain should first suggest symptomatic neuralgia through involvement of the cranial nerves — trigeminal, glossopharyngeal, superior laryngeal — even if asymptomatic neuralgia are the most frequent. Earaches should be investigated through a search for involvement of the ear at the pinna, the external acoustic conduit, and the tympanic membrane. If the ear examination is normal, pain irradiating from the masticatory apparatus, the parotid, or the oropharynx is undertaken, with a systematic search for a tumoral cause.

Ethmoidal Involvement in ???Imploding??? (Silent) Sinus Syndrome

A 32-year-old woman presented with mild enophthalmos of her right eye of recent onset. A CT scan revealed characteristic findings of silent sinus syndrome, involving not just the maxillary but the less frequently reported ethmoid sinus as well. A clinically and radiologically noted shrunken and lateralized middle turbinate was a strong pointer to the suspected cause. The symptoms resolved with endoscopic sinus drainage.

Rhinocerebral mucormycosis: An analysis of probable mode of spread and its implication in an early diagnosis and treatment

The study was done in two parts:Analysis of CT scan findings of 17 cases of mucormycosis to determine paranasal sinus, orbital and intra-cranial involvement.Cadaveric dissections of the ethmoid complex anatomy to correlate the probable mode of spread. Ethmoidal sinus was found to be the most commonly involved. The disease probably appears first here, spreads to orbit through the lamina papyracea and then through the retro-orbital region, intra-cranially. Our aim would be to diagnose the disease at the stage of ethmoid involvement. In immuno-compromised patients, if headache, peri- or retro-orbital pain or blood stained nasal discharge occur; a CT scan of the paranasal sinuses and a nasal endoscopy with biopsy from anterior ethmoids, if this area shows pathology then CT scan must be performed. If this is positive for mucormycosis, surgical debridement of the involved sinuses is to be done and Amphotericin B as intra-venous infusion and treatment of underlying condition is started.

Report of the American Rhinologic Society

The 38th Annual Scientific Session of the American Rhinologic Society was held on September 12,1992, in Washington, DC. Selected points from presentations and panel discussions are presented. The first presentation of the session was delivered by David W. Kennedy, MD, Philadelphia, Pa. He and coauthor Mohammed Hassab presented a four-level staging system of sinusitis based on severity seen on computed tomographic findings. Group 1 consisted of those with unilateral disease, anatomic abnormalities only, or bilateral ethmoid involvement. Patients having bilateral ethmoid involvement with one dependent sinus comprised group 2. Group 3 patients had involvement of two or more dependent sinuses. Last, individuals with diffuse nasal polyposis were placed in group 4. During the mean follow-up study time of 18 months, this staging seemed to strongly correlate with surgical outcomes, the higher grades having lower likelihoods of success. The authors also noted that significant improvement from symptoms did not correlate well

Maxillary ameloblastoma: Case report

Ameloblastoma of the maxilla is an unusual epithelial tumor of odontogenic origin. Although it is considered benign, it can behave in a slowly growing infiltrative fashion, with multiple recurrences and eventual intracranial, or even distant, spread. Information on this tumor consists, to a large extent, of case reports presented in the oral surgery literature. This study is a retrospective review of our combined institutional experience with nasomaxillary tumors from 1980 to 1988. Among these cases were four patients with maxillary ameloblastoma, two males and two females, ranging in age from 16 to 66 years at presentation. Disease extent varied from ameloblastoma localized to a cyst in the maxillary sinus to extensive maxillary and ethmoid involvement. Follow-up ranged from 2 to 13 years, and disease course varied from apparent disease control to persistent intracranial tumor, despite attempts at extirpation. An analysis of this experience and the related literature is presented, along with recommendations for radical therapy, when appropriate, to best ensure control.

Surgery for sinusitis and aspirin triad

An 11-year retrospective study was conducted to evaluate the surgical treatment of sinusitis in aspirin-triad patients. Twenty-five patients were selected for surgery when their sinus disease and asthma progressed despite intense medical treatment. Sixteen patients had radiographic evidence of severe ethmoid disease, and their initial surgical procedures were limited (i.e., bilateral intranasal ethmoidectomies). Of these 16 patients, 6 required subsequent surgery for recurrent sinusitis. Nine of the 25 patients had radiographic evidence of severe antral, as well as ethmoid, disease. Their initial surgical procedures were radical, i.e., bilateral Caldwell-Luc operations with intranasal and transantral sphenoethmoidectomies. None of these 9 patients required further surgical treatment for control. This review indicates that if antral and sphenoid disease are detected in association with ethmoid involvement, a radical surgical approach is the operation of choice.